“I SUD­DENLY BE­CAME LAC­TOSE IN­TOL­ER­ANT AF­TER A BAD BOUT OF FOOD POI­SON­ING.”

A gas­troen­terol­o­gist ex­plains why this can hap­pen and what to do about it.

Shape (Singapore) - - Contents -

Some­time last Au­gust, I had a se­ri­ous bout of food poi­son­ing. My stom­ach has not been the same since. From just food poi­son­ing, it turned into a long-drawn bat­tle with an in­cred­i­bly weak­ened di­ges­tive sys­tem and, sur­pris­ingly, a se­vere case of se­condary lac­tose in­tol­er­ance.

I’d never had a prob­lem with dairy be­fore this. I used to drink a cup of milk ev­ery other day and was a huge cheese eater. But since that Au­gust in­ci­dent, I’ve come to ac­cept that my stom­ach will churn and I’ll have the runs if I drink even the slight­est hint of milk.

Ini­tially, I thought it was be­cause I was still re­cov­er­ing from food poi­son­ing. But af­ter see­ing three doc­tors over the span of six months and track­ing my diet, I re­alised that my big­gest trig­ger for an up­set stom­ach is dairy. The worst cul­prits so far are fresh milk, ice cream (the tragedy!) and yo­gurt.

I se­ri­ously never thought that this could hap­pen to me – or any­one else for that mat­ter. And I’d never heard of any­one de­vel­op­ing lac­tose in­tol­er­ance af­ter food poi­son­ing. So, just what hap­pened to my gut health? I sussed out Dr Gwee Kok Ann, med­i­cal direc­tor and con­sul­tant gas­troen­terol­o­gist at Gle­nea­gles Hospi­tal, to find out more.

Is it pos­si­ble to de­velop lac­tose in­tol­er­ance af­ter a bad bout of food poi­son­ing?

DR GWEE Yes, it is pos­si­ble. The en­zyme re­spon­si­ble for di­gest­ing lac­tose, which is known as lac­tase, sits on the tips of villi, the fin­ger-like pro­jec­tions on the in­ter­nal in­testi­nal lin­ing. When there is an in­fec­tion

in­volv­ing the small in­tes­tine, the lac­tase is bound to be dam­aged, thus re­duc­ing one’s abil­ity to digest and ab­sorb lac­tose. Some­times, af­ter an episode of food poi­son­ing, cer­tain func­tions of the in­tes­tine may change. In­testi­nal move­ments may be­come faster and more sen­si­tive to gas, and an im­bal­ance of the nat­u­rally-oc­cur­ring bac­te­ria in the colon can also re­sult in greater fer­men­ta­tion of lac­tose, which again leads to more gas. This dam­age to the in­testi­nal lin­ing may take up to two months to re­cover.

Is it pos­si­ble to sud­denly de­velop ir­ri­ta­ble bowel syn­drome (IBS) af­ter food poi­son­ing?

DR GWEE An episode of se­vere food poi­son­ing is a well-recog­nised cause of IBS. This is called post-in­fec­tion IBS. Other com­mon trig­gers of IBS in­clude an­tibi­otic treat­ment, ma­jorly stress­ful life events and surgery to the gall blad­der or pelvis.

Can some­one who de­vel­oped se­condary lac­tose in­tol­er­ance “train” their body to tol­er­ate dairy again?

DR GWEE Most peo­ple with se­condary lac­tose in­tol­er­ance do not lose all their abil­ity to tol­er­ate lac­tose. There is usu­ally some resid­ual lac­tase en­zyme on the in­testi­nal lin­ing that will al­low for ab­sorp­tion of small quan­ti­ties of lac­tose.

How well the in­tes­tine can han­dle the lac­tose load will also de­pend on the speed at which it moves through the in­tes­tine. The faster the in­testi­nal move­ments, the worse the lac­tose in­tol­er­ance will be. The trick is to avoid con­sum­ing dairy with sub­stances that stim­u­late in­testi­nal move­ments such as cof­fee, and to eat some food be­fore con­sum­ing dairy.

Tak­ing pro­bi­otics could also help to im­prove the bal­ance of colonic bac­te­ria in the gut, so that there is less gaseous fer­men­ta­tion of lac­tose, and re­duce in­flam­ma­tion in the colon so that it is less sen­si­tive to gas. It is also pos­si­ble for pro­bi­otics to pro­mote re­cov­ery of lac­tase en­zymes and im­prove in­testi­nal per­me­abil­ity.

Dr Gwee’s ex­pla­na­tion sheds light on why I’m most in­tol­er­ant to fresh milk, ice cream and yo­gurt since th­ese are all non-solid items that pass through the in­testi­nal tract very quickly. Cur­rently, I’m slowly re­build­ing my gut health by tak­ing pro­bi­otic tablets daily. I’m also heed­ing the ad­vice of Win­nie Ong, fer­men­ta­tion ex­pert and co-founder of lo­cal kom­bucha and kefir maker Craft & Cul­ture, to order a mix of pro­bi­otic-rich foods like miso or kim­chi when­ever I eat out. This in­tro­duces dif­fer­ent strains of good bac­te­ria to my sys­tem to strengthen it.

Since I was of­fi­cially di­ag­nosed as be­ing lac­tose in­tol­er­ant ear­lier in Jan­uary, I’ve also been con­sciously avoid­ing dairy. So far, my ef­forts seem to be pay­ing off. From need­ing to clear my bow­els five or six times a day, I now go just once in the morn­ings (my usual). My gut seems less re­ac­tive as well, but I still don’t know if I’ll one day be able to tol­er­ate dairy again. The thought of never in­dulging in a scoop of creamy gelato def­i­nitely sad­dens me, but it’s a price I’m will­ing to pay if it means good gut health.

Some­times, af­ter an episode of food poi­son­ing, cer­tain func­tions of the in­tes­tine may also change. In­testi­nal move­ments may be­come faster and more sen­si­tive to gas, and an im­bal­ance of the nat­u­rally-oc­cur­ring bac­te­ria in the colon can also re­sult in greater fer­men­ta­tion of lac­tose.

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